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ST. LOUIS (AP) - Death row inmate Russell Bucklew was still alive Thursday, after a rare last-minute stay of execution from the U.S. Supreme Court. What happens to him next will be up to other judges after the justices simply directed a lower court to take another look at the case.

The Supreme Court did not specify its reasons, leaving open the question of whether the ruling shows a growing weariness of lethal injection in general or trepidation specifically about Bucklew’s medical condition, which affects his veins.

Bucklew, convicted of killing another man during a crime rampage in 1996, had originally been scheduled to die early Wednesday. He would have been the first inmate put to death since a botched execution last month in Oklahoma. In a flurry of court rulings, a stay was granted, lifted, and granted again. Finally, the Supreme Court halted the execution, ruling that a lower federal court needs to reconsider the case.

“This is out of the ordinary,” said Michael Gans, clerk for the 8th U.S. Circuit Court of Appeals in St. Louis, where the Supreme Court returned the case. “There’s just a variety of things that could happen.”

The court could simply review briefs, hold a hearing, or send the case down to the district court level. Because Bucklew’s death warrant expired after 24 hours, Missouri Attorney General Chris Koster would need to ask the Missouri Supreme Court to set a new execution date. A spokesman for Koster said no date will be set until the appeals process is complete.

Bucklew’s attorneys said the stay gives lower federal courts time to consider his claim that his execution “would violate his rights under the Eighth Amendment to be free from cruel and unusual punishment.” His lawyers contend that his condition, which causes weakened and malformed blood vessels, as well as tumors in his nose and throat, could result in a painful, even torturous death.

In the Oklahoma case, inmate Clayton Lockett’s vein apparently collapsed and he suffered a fatal heart attack 43 minutes after the process began. That stirred new concerns about lethal injection in an era when many states - including Oklahoma, Missouri and Texas - obtain execution drugs in secret from unidentified compounding pharmacies. Death penalty opponents say the secrecy raises the risk of something going wrong.

What remained unclear was whether the drug concerns are starting to weigh on the Supreme Court, or if justices acted simply based on Bucklew’s condition, known as cavernous hemangioma.

Deborah Denno, a Fordham University law professor who studies the death penalty, believes the court was influenced by the botched execution in Oklahoma and two other cases this year in which inmates appeared to suffer during the process.

“I do think it suggests a change in attitude,” Denno said. “They (Supreme Court justices) are not immune to the huge amount of press commentary and international reaction to these botches.”

But Morley Swingle, a former Cape Girardeau County prosecutor who handled the original case, said he hoped Bucklew was executed “before too long.”

“It’s sort of ironic that a person is considered too sick to kill,” said Swingle, now an attorney in Colorado. “I think it’s an almost hysterical overreaction to the Oklahoma botched execution.

“I hope that very quickly this whole claim is proven to be a bunch of hogwash,” Swingle said.

Prosecutors said Bucklew, angry with Stephanie Pruitt for breaking up with him, followed her to the home that she shared with Michael Sanders. Bucklew shot and killed Sanders in front of Pruitt, her two daughters and Sanders’ two sons. He handcuffed and beat Pruitt, drove her to a secluded area and raped her. Authorities also say he shot at a state trooper and missed, and after escaping from jail, attacked Pruitt’s mother.